Endometriosis-Associated Macrophages: Origin, Phenotype, and Function

Chloe Hogg, Andrew W Horne, Erin Greaves
Frontiers in endocrinology · 2020 · vol. 11 , pp. 7 · doi:10.3389/fendo.2020.00007 · PMID:32038499 · W3001524003
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This review examines the origin, phenotype, and function of macrophages in endometriosis, highlighting their critical roles in lesion development and pain, and the potential for therapeutic targeting.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This paper reviews what is known about macrophages in endometriosis, focusing on their possible origins (tissue-resident versus recruited monocyte-derived), phenotypic heterogeneity, and functions in lesion growth, vascularization, innervation, and pain generation. Drawing on evidence from immune-cell studies and broader macrophage biology, it argues that under disease-modified conditions macrophage homeostasis-like roles can shift to disease-promoting activities, while noting that direct evidence for macrophage origin and phenotypic diversity in endometriosis remains limited. It discusses etiologic theories (e.g., retrograde menstruation and potential roles for endometrial, neonatal, stem/progenitor, and metaplastic origins) and how these could plausibly alter macrophage recruitment and differentiation, but emphasizes gaps in proof for key proposed mechanisms. This paper is centrally about endometriosis — it reviews endometriosis-associated macrophage origin, phenotype, and function as they relate to lesion establishment and symptoms.

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Abstract

Endometriosis is a complex, heterogeneous, chronic inflammatory condition impacting ~176 million women worldwide. It is associated with chronic pelvic pain, infertility, and fatigue, and has a substantial impact on health-related quality of life. Endometriosis is defined by the growth of endometrial-like tissue outside the uterus, typically on the lining of the pelvic cavity and ovaries (known as "lesions"). Macrophages are complex cells at the center of this enigmatic condition; they are critical for the growth, development, vascularization, and innervation of lesions as well as generation of pain symptoms. In health, tissue-resident macrophages are seeded during early embryonic life are vital for development and homeostasis of tissues. In the adult, under inflammatory challenge, monocytes are recruited from the blood and differentiate into macrophages in tissues where they fulfill functions, such as fighting infection and repairing wounds. The interplay between tissue-resident and recruited macrophages is now at the forefront of macrophage research due to their differential roles in inflammatory disorders. In some cancers, tumor-associated macrophages (TAMs) are comprised of tissue-resident macrophages and recruited inflammatory monocytes that differentiate into macrophages within the tumor. These macrophages of different origins play differential roles in disease progression. Herein, we review the complexities of macrophage dynamics in health and disease and explore the paradigm that under disease-modified conditions, macrophages that normally maintain homeostasis become modified such that they promote disease. We also interrogate the evidence to support the existence of multiple phenotypic populations and origins of macrophages in endometriosis and how this could be exploited for therapy.

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Condition tags

mesh:D004715mesh:D017699endometriosischronic_pelvic_paininfertility

MeSH descriptors

Endometriosis Macrophages Macrophages Endometriosis Endometriosis Endometriosis Female Humans Macrophages Pelvic Pain Pelvic Pain Pelvic Pain Pelvic Pain Peritoneal Diseases Peritoneal Diseases Peritoneal Diseases Phenotype

Citation neighborhood

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References (100)

Cited by (50)

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